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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Suicide Prevention. Show all posts
Showing posts with label Suicide Prevention. Show all posts

Friday, March 22, 2024

Nearly 50,000 veterans used free emergency suicide prevention in first year of program, VA says

K. Watson and S. Cook
CBS News
Originally posted 17 Jan 24

Here is an excerpt:

A 2021 Brown University study estimated that more than 30,000 veterans of post-9/11 conflicts have died by suicide, more than four times the 7,057 U.S. military personnel killed at the time in those conflicts. 

And the veteran suicide rate has outpaced the rate of the general U.S. public. A 2023 report by the Department of Veterans Affairs found that in 2021, the suicide rate for veterans was 71.8% higher than non-veterans when adjusted for age and sex differences.

That same report found that 6,392 veterans died by suicide in 2021, an average of more than 17 veterans taking their lives every day.

In November 2021, the Biden administration released a new national strategy to reduce military and veteran suicide, calling it a "public health and national security crisis."

"I've often said that we have only one truly sacred obligation as Americans—to prepare and properly equip our women and men in uniform when we send them into harm's way, and to care for them and their families when they return," President Biden wrote in the introduction to the strategy document. "Yet for too many who are serving or have served, we are falling short."

Key points:

49,714 veterans accessed the program: This translates to over $64 million saved in healthcare costs.

Program covers: Emergency room care, inpatient/crisis residential care for up to 30 days, and outpatient care for up to 90 days.

Accessibility: Veterans don't need to be enrolled in the VA system to qualify.

Monday, February 26, 2024

Hope for Suicide Prevention

Ellen Barry
The New York Times
Originally published 21 Feb 24

Here is an excerpt:

Research has demonstrated that suicide is most often an impulsive act, with a period of acute risk that passes in hours, or even minutes. Contrary to what many assume, people who survive suicide attempts often go on to do well: Nine out of 10 of them do not die by suicide.

Policymakers, it seems, are paying attention. I have been reporting on mental health for The New York Times for two years, and in today’s newsletter I will look at promising, evidence-based efforts to prevent suicide.

A single element

For generations, psychiatrists believed that, in the words of the British researcher Norman Kreitman, “anyone bent on self-destruction must eventually succeed.”

Then something strange and wonderful happened: Midway through the 1960s, the annual number of suicides in Britain began dropping — by 35 percent in the following years — even as tolls crept up in other parts of Europe.

No one could say why. Had medicine improved, so that more people survived poisoning? Were antidepressant medications bringing down levels of despair? Had life in Britain just gotten better?

The real explanation, Kreitman discovered, was none of these. The drop in suicides had come about almost by accident: As the United Kingdom phased out coal gas from its supply to household stoves, levels of carbon monoxide decreased. Suicide by gas accounted for almost half of the suicides in 1960.

It turns out that blocking access to a single lethal means — if it is the right one — can make a huge difference.

The strategy that arose from this realization is known as “means restriction” or “means safety,” and vast natural experiments have borne it out. When Sri Lanka restricted the import of toxic pesticides, which people had ingested in moments of crisis, its suicide rate dropped by half over the next decade.

Here is my summary

The article discusses new suicide prevention measures in the U.S., where suicide rates have risen 35% in recent decades. This contrasts with global trends of declining suicide rates.
  • It highlights how installing barriers on bridges, buildings, and other high structures can deter impulsive suicide attempts. Many communities are now considering such barriers.
  • Research shows most who survive a suicide attempt go on to live their lives and not die by suicide later. This suggests preventing access to lethal means in moments of crisis can save lives.
  • Restricting access to highly lethal means like guns and toxic pesticides has significantly reduced suicide rates when implemented in other countries.
  • In the U.S., red flag laws that temporarily remove guns from high-risk individuals have been associated with drops in firearm suicides.
  • Educating gun owners on safe storage habits is another promising approach, as is providing incentives for measures like locking devices or gun safes.
  • Even brief counseling for gun owners has proven effective in getting people to voluntarily store guns securely and prevent access during periods of risk.
In summary, the text highlights several evidence-based strategies for reducing access to lethal means during periods of acute suicide risk, thereby giving people a chance to recover and survive their suicidal crises.

Thursday, January 25, 2024

Listen, explain, involve, and evaluate: why respecting autonomy benefits suicidal patients

Samuel J. Knapp (2024)
Ethics & Behavior, 34:1, 18-27
DOI: 10.1080/10508422.2022.2152338


Out of a concern for keeping suicidal patients alive, some psychotherapists may use hard persuasion or coercion to keep them in treatment. However, more recent evidence-supported interventions have made respect for patient autonomy a cornerstone, showing that the effective interventions that promote the wellbeing of suicidal patients also prioritize respect for patient autonomy. This article details how psychotherapists can incorporate respect for patient autonomy in the effective treatment of suicidal patients by listening to them, explaining treatments to them, involving them in decisions, and inviting evaluations from them on the process and progress of their treatment. It also describes how processes that respect patient autonomy can supplement interventions that directly address some of the drivers of suicide.

Public Impact Statement

Treatments for suicidal patients have improved in recent years, in part, because they emphasize promoting patient autonomy. This article explains why respecting patient autonomy is important in the treatment of suicidal patients and how psychotherapists can integrate respect for patient autonomy in their treatments.

Dr. Knapp's article discusses the importance of respecting patient autonomy in the treatment of suicidal patients within the framework of principle-based ethics. It highlights the ethical principles of beneficence, nonmaleficence, justice, respecting patient autonomy, and professional-patient relationships. The article emphasizes the challenges psychotherapists face in balancing the promotion of patient well-being with the need to respect autonomy, especially when dealing with suicidal patients.

Fear and stress in treating suicidal patients may lead psychotherapists to prioritize more restrictive interventions, potentially disregarding the importance of patient autonomy. The article argues that actions minimizing respect for patient autonomy may reflect a paternalistic attitude, which is implementing interventions without patient consent for the sake of well-being.

The problems associated with paternalistic interventions are discussed, emphasizing the importance of patients' internal motivation to change. The article advocates for autonomy-focused interventions, such as cognitive behavior therapy and dialectical behavior therapy, which have been shown to reduce suicide risk and improve outcomes. It suggests that involving patients in treatment decisions, listening to their experiences, and validating their feelings contribute to more effective interventions.

The article provides recommendations on how psychotherapists can respect patient autonomy, including listening carefully to patients, explaining treatment processes, involving patients in decisions, and inviting them to evaluate their progress. The ongoing nature of the informed consent process is stressed, along with the benefits of incorporating patient feedback into treatment. The article concludes by acknowledging the need for a balance between beneficence and respect for patient autonomy, particularly in cases of imminent danger, where temporary prioritization of beneficence may be necessary.

In summary, the article underscores the significance of respecting patient autonomy in the treatment of suicidal patients and provides practical guidance for psychotherapists to achieve this while promoting patient well-being.

Monday, January 15, 2024

The man helping prevent suicide with Google adverts

Looi, M.-K. (2023).

Here are two excerpts:

Always online

A big challenge in suicide prevention is that people often experience suicidal crises at times when they’re away from clinical facilities, says Nick Allen, professor of psychology at the University of Oregon.

“It’s often in the middle of the night, so one of the great challenges is how can we be there for someone when they really need us, which is not necessarily when they’re engaged with clinical services.”

Telemedicine and other digital interventions came to prominence at the height of the pandemic, but “there’s an app for that” does not always match the patient in need at the right time. Says Onie, “The missing link is using existing infrastructure and habits to meet them where they are.”

Where they are is the internet. “When people are going through suicidal crises they often turn to the internet for information. And Google has the lion’s share of the search business at the moment,” says Allen, who studies digital mental health interventions (and has had grants from Google for his research).

Google’s core business stores information from searches, using it to fuel a highly effective advertising network in which companies pay to have links to their websites and products appear prominently in the “sponsored” sections at the top of all relevant search results.

The company holds 27.5% of the digital advertising market—earning the company around $224bn from search advertising alone in 2022.

If it knows enough about us to serve up relevant adverts, then it knows when a user is displaying red flag behaviour for suicide. Onie set out to harness this.

“It’s about the ‘attention economy,’” he says, “There’s so much information, there’s so much noise. How do we break through and make sure that the first thing that people see when they’re contemplating suicide is something that could be helpful?”


At its peak the campaign was responding to over 6000 searches a day for each country. And the researchers saw a high level of response.

Typically, most advertising campaigns see low engagement in terms of clickthrough rates (the number of people that actually click on an advert when they see it). Industry benchmarks consider 3.17% a success. The Black Dog campaign saw 5.15% in Australia and 4.02% in the US. Preliminary data show Indonesia to be even higher—as much as 12%.

Because this is an advertising campaign, another measure is cost effectiveness. Google charges the advertiser per click on its advert, so the more engaged an audience is (and thus what Google considers to be a relevant advert to a relative user) the higher the charge. Black Dog’s campaign saw such a high number of users seeing the ads, and such high numbers of users clicking through, that the cost was below that of the industry average of $2.69 a click—specifically, $2.06 for the US campaign. Australia was higher than the industry average, but early data indicate Indonesia was delivering $0.86 a click.

I could not find a free pdf.  The link above works, but is paywalled. Sorry. :(

Saturday, July 16, 2022

988 becomes the new 3-digit suicide prevention hotline on July 16: What to know

Christine Fernando
USA Today
Originally posted 8 JUL 22

Here is an excerpt:

Here's what you need to know:

How does 988 work?

What to know: After dialing or texting 988, you'll be connected with a trained mental health professional at a local or regional crisis center. If your local center cannot connect you to a counselor, national backup centers can pick up the call. The lifeline is administered by the nonprofit Vibrant Emotional Health.

That's how it has worked for the National Suicide Prevention Lifeline number, and the setup will continue after 988 is launched.

What experts say: The shortened, more accessible lifeline marks "a transformative moment in terms of thinking about approaching crisis care," said Miriam Delphin-Rittmon, an assistant secretary at the Substance Abuse and Mental Health Services Administration, on Thursday.

The launch also comes amid what experts have called a mental health crisis in the U.S. amid the COVID-19 pandemic.

Are states prepared?

What to know: For many advocates, 988 represents an opportunity to expand services but also a challenge because of possible added pressure on already strained mental health crisis response systems. Some advocates have questioned whether states will be ready for the increased call volume projected after the switch to the 988 model.

In the first year of 988's implementation, the number of contacts for the lifeline is expected to increase to 7.6 million – a twofold increase compared with the 3.3 million calls, texts or chats in 2020, according to a report in December 2021 from SAHMSA.

What experts say: Delphin-Rittmon acknowledged that some crisis response centers are worried about the size of workforces in their states and about resources for this launch. She said she has been working with state representatives on funding and to "assess their overall readiness." .

The launch of 988 provides "an opportunity to expose gaps and weaknesses in our system," which would allow centers to see where additional investments may be needed, said Angela Kimball, national director of advocacy and public policy at the National Alliance on Mental Illness.

"Will it work perfectly?" she said. "No. Because changing crisis response won't happen overnight."

Thursday, July 7, 2022

Preventing Suicide Through Better Firearm Safety Policy in the United States

J. W. Swanson
Psychiatric Services
Volume 72, Issue 2
February 01, 2021, 174-179


The U.S. suicide rate continues to increase, despite federal investment in developing preventive behavioral health care interventions. Important determinants of suicide—social, economic, and circumstantial—have little or no connection to psychopathology. Firearm injuries account for over half of suicides, and firearm access is perhaps the most important modifiable determinant. Thus gun safety policy deserves special attention as a pathway to suicide prevention. This article summarizes arguments for several recommended statutory modifications to firearm restrictions at the state level. The policy challenge is to develop and implement evidence-based strategies to keep guns out of the hands of people at highest risk of suicide, without unduly infringing the rights of a large number of gun owners who are unlikely to harm anyone. Recommendations for states include expansion and refinement of legal criteria prohibiting firearm purchase, possession, or access to better align with suicide risk, including prohibition for persons with brief involuntary psychiatric holds or repeated alcohol-impaired driving convictions; enactment of extreme risk protection order laws, which allow temporary removal of firearms from persons who are behaving dangerously, and entering purchase prohibition data for these persons in the FBI’s background-check database; and adoption of an innovative policy known as precommitment against suicide as well as voluntary self-enrollment in the FBI’s background-check database.

  • Suicide is caused by many factors in addition to mental illness and often cannot be prevented by mental health treatment alone.
  • Access to firearms is one of the most important modifiable determinants of suicide mortality in the United States.
  • Evidence-based firearm restrictions and policies that limit gun access to people who pose a clear risk of intentional self-harm could prevent many suicides without infringing the rights of lawful gun owners.
Important data points

Overall, 60% of males who died by suicide had no known mental health conditions. Across all age groups, firearm suicides were more common among males without known mental health conditions compared with males who had known mental health conditions. Between 32% and 40% of all young and middle-aged adults in the study had a history of problematic substance use. Between 43% and 48% of all young and middle-aged adults tested positive for alcohol at the time of their death.

Friday, May 6, 2022

Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system

A. Carter, A. Butler, et al. (2022)
The Lancet, Vol 44, 101266



People who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system.


Thirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult.

Research in context

Evidence before this study

One previous review had synthesised the literature regarding the effectiveness of interventions during incarceration, but no studies had investigated the effectiveness of interventions to prevent suicidal thoughts and/or behaviours among people in contact with the multiple other settings in the criminal justice system. We searched Embase, PsycINFO, and MEDLINE on 1 June 2021 using variants and combinations of search terms relating to suicide, self-harm, prevention, and criminal justice system involvement (suicide, self-injury, ideation, intervention, trial, prison, probation, criminal justice).
 Added value of this study

Our review identified gaps in the evidence base, including a dearth of robust evidence regarding the effectiveness of interventions across non-custodial criminal justice settings and from low- and middle-income countries. We identified the need for studies examining suicide prevention initiatives for people who were detained in police custody, on bail, or on parole/license, those serving non-custodial sentences, and those after release from incarceration. Furthermore, our findings suggested an absence of interventions which considered specific population groups with diverse needs, such as women, First Nations people, and young people.

Wednesday, July 22, 2020

FCC Approves 988 as Suicide Hotline Number

Jennifer Weaver
Originally posted 16 July 20

A three-digit number to connect to suicide prevention and mental health crisis counselors has been approved.

The Federal Communications Commission voted unanimously Thursday to make 988 the number people can call to be connected directly to the National Suicide Prevention Hotline.

Phone service providers have until July 2022 to implement the new number. The 10-digit number is currently 1-800-273-8255 (TALK).

Tuesday, October 15, 2019

Want To Reduce Suicides? Follow The Data — To Medical Offices, Motels And Even Animal Shelters

Maureen O’Hagan
Kaiser Health News
Originally published September 23, 2019

Here is an excerpt:

Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to help. That’s where Debra Darmata, Washington County’s suicide prevention coordinator, comes in. Part of Darmata’s job involves running these training programs, which she described as like CPR but for mental health.

The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more.

It is a relatively straightforward process: Participants are taught to recognize signs of distress. Then they learn how to ask a person if he or she is in crisis. If so, the participants’ role is not to make the person feel better or to provide counseling or anything of the sort. It is to call a crisis line, and the experts will take over from there.

Since 2014, Darmata said, more than 4,000 county residents have received training in suicide prevention.

“I’ve worked in suicide prevention for 11 years,” Darmata said, “and I’ve never seen anything like it.”

The sheriff’s office has begun sending a deputy from its mental health crisis team when doing evictions. On the eviction paperwork, they added the crisis line number and information on a county walk-in mental health clinic. Local health care organizations have new procedures to review cases involving patient suicides, too.

The info is here.

Wednesday, September 18, 2019

California Requires Suicide Prevention Phone Number On Student IDs

Mark Kreider
Kaiser Health News
Originally posted August 30, 2019

Here is an excerpt:

A California law that has greeted students returning to school statewide over the past few weeks bears a striking resemblance to that Palo Alto policy from four years ago. Beginning with the 2019-20 school year, all IDs for California students in grades seven through 12, and in college, must bear the telephone number of the National Suicide Prevention Lifeline. That number is 800-273-TALK (8255).

“I am extremely proud that this strategy has gone statewide,” said Herrmann, who is now superintendent of the Roseville Joint Union High School District near Sacramento.

The new student ID law marks a statewide response to what educators, administrators and students themselves know is a growing need.

The numbers support that idea — and they are as jarring as they are clarifying.

Suicide was the second-leading cause of death in the United States among people ages 10 to 24 in 2017, according to the U.S. Centers for Disease Control and Prevention.  The suicide rate among teenagers has risen dramatically over the past two decades, according to data from the CDC.

The info is here.

Tuesday, August 28, 2018

As calls to the Suicide Prevention Lifeline surge, under-resourced centers struggle to keep up

Vivekae Kim
Originally posted August 5, 2018

Here is an excerpt:

To accommodate the rising call volume, Dr. Draper, the director of the Lifeline, says local crisis centers need more resources–and that a lack of resources contributes to centers leaving the network or shutting down. From 2008-2012, nine centers dropped out of the network and from 2013-2017, 23 centers dropped out. Just this year, three centers shut down.

Remaining centers do what they can to stay functioning. This often means taking on extra contracts, like running local crisis lines, to support their suicide prevention work.

Crisis Call Center, a Lifeline backup center in Nevada, operates a sexual assault support service program and a substance abuse hotline. They also provide child protective service reports and take elder protective service reports after hours. Rachelle Pellissier, its executive director, says they have to “cobble together” these different funding streams to offset the costs of the suicide prevention calls they take.

“We really need about $1.1 million to run this organization,” said Pellissier.

Centers like Provident in Missouri rely on their local United Way. The money they receive from the Lifeline, even as a backup center with more support, “pays for maybe two salaries of my 15 person team,” said Jane Smith, the director of life crisis services for Provident. “We’re a money-losing entity at Provident.”

If backup centers are unable to take a call, that call is routed from one backup center to the next, until a counselor can talk. “All the calls can be answered. The only question is, how long do people wait?” Draper said.

The info is here.

Tuesday, May 22, 2018

Truckers Line Up Under Bridge To Save Man Threatening Suicide

Vanessa Romo
Originally published April 24, 2018

Here is an excerpt:

"It provides a safety net for the person in case they happen to lose their grip and fall or if they decide to jump," Shaw said. "With the trucks lined up underneath they're only falling about five to six feet as opposed 15 or 16."

After about two hours of engaging with officials the distressed man willingly backed off the edge and is receiving help, Shaw said.

"He was looking to take his own life but we were able to talk to him and find out what his specific trigger was and helped correct it," Shaw said.

In all, the ordeal lasted about three hours.

The article is here.

Sunday, September 3, 2017

The bold new fight to eradicate suicide

Simon Usborne
The Guardian
Originally published August 1, 2017

Here is an excerpt:

They call it “Zero Suicide”, a bold ambition and slogan that emerged from a Detroit hospital more than a decade ago, and which is now being incorporated into several NHS trusts. Since our first meeting, Steve has himself embraced the idea, and in May of this year held talks with Mersey Care, one of the specialist mental health trusts already applying a zero strategy. His plans are at an early stage, but he is setting out to create a Zero Suicide foundation. He wants it to identify good practices across the 55 mental health trusts in England and create a new strategy to be applied everywhere.

The zero approach is a proactive strategy that aims to identify and care for all those who may be at risk of suicide, rather than reacting once patients have reached crisis point. It emphasises strong leadership, improved training, better patient-screening and the use of the latest data and research to make changes without fear or delay. It is a joined-up strategy that challenges old ideas about the inevitability of suicide, the stigma that surrounds it, and the idea that if a reduction target is achieved, the deaths on the way to it are somehow acceptable. “Even if you believe we are never going to eradicate suicide, we must strive towards that,” Steve said to me. “If zero isn’t the right target, then what is?”

Zero Suicide is not radical, incorporating as it does several existing prevention strategies. But that it should be seen as new and daringly ambitious reveals much about how slowly attitudes have changed. In the 1957 book The Uses of Literacy: Aspects of Working-Class Life, a semi-autobiographical examination of the cultural upheavals of the 1950s, Richard Hoggart recalled his upbringing in Leeds. “Every so often one heard that so-and-so had ‘done ’erself in’ … or ‘put ’er ’ead in the gas-oven’,” he wrote. “It did not happen monthly or even every season, and not all attempts succeeded; but it happened sufficiently often to be part of the pattern of life.” He wondered how “suicide could be accepted – pitifully but with little suggestion of blame – as part of the order of existence”.

The article is here.

Friday, April 21, 2017

Individuals at High Risk for Suicide Are Categorically Distinct From Those at Low Risk.

Tracy K. Witte, Jill M. Holm-Denoma, Kelly L. Zuromski, Jami M. Gauthier, & John Ruscio
Psychological Assessment, Vol 29(4), Apr 2017, 382-393


Although suicide risk is often thought of as existing on a graded continuum, its latent structure (i.e., whether it is categorical or dimensional) has not been empirically determined. Knowledge about the latent structure of suicide risk holds implications for suicide risk assessments, targeted suicide interventions, and suicide research. Our objectives were to determine whether suicide risk can best be understood as a categorical (i.e., taxonic) or dimensional entity, and to validate the nature of any obtained taxon. We conducted taxometric analyses of cross-sectional, baseline data from 16 independent studies funded by the Military Suicide Research Consortium. Participants (N = 1,773) primarily consisted of military personnel, and most had a history of suicidal behavior. The Comparison Curve Fit Index values for MAMBAC (.85), MAXEIG (.77), and L-Mode (.62) all strongly supported categorical (i.e., taxonic) structure for suicide risk. Follow-up analyses comparing the taxon and complement groups revealed substantially larger effect sizes for the variables most conceptually similar to suicide risk compared with variables indicating general distress. Pending replication and establishment of the predictive validity of the taxon, our results suggest the need for a fundamental shift in suicide risk assessment, treatment, and research. Specifically, suicide risk assessments could be shortened without sacrificing validity, the most potent suicide interventions could be allocated to individuals in the high-risk group, and research should generally be conducted on individuals in the high-risk group.

The article is here.

Tuesday, March 28, 2017

Facebook Is Using Artificial Intelligence To Help Prevent Suicide

Alex Kantrowitz
Originally published March 1, 2017

Facebook is bringing its artificial intelligence expertise to bear on suicide prevention, an issue that’s been top of mind for CEO Mark Zuckerberg following a series of suicides livestreamed via the company’s Facebook Live video service in recent months.

“It’s hard to be running this company and feel like, okay, well, we didn’t do anything because no one reported it to us,” Zuckerberg told BuzzFeed News in an interview last month. “You want to go build the technology that enables the friends and people in the community to go reach out and help in examples like that.”

Today, Facebook is introducing an important piece of that technology — a suicide-prevention feature that uses AI to identify posts indicating suicidal or harmful thoughts. The AI scans the posts and their associated comments, compares them to others that merited intervention, and, in some cases, passes them along to its community team for review. The company plans to proactively reach out to users it believes are at risk, showing them a screen with suicide-prevention resources including options to contact a helpline or reach out to a friend.

The article is here.

Friday, December 2, 2016

An Improved Virtual Hope Box: An App for Suicidal Patients

Principal Investigator: Nigel Bush, Ph.D.
Organization: National Center for Telehealth & Technology

One of the key approaches in treating people who are depressed and thinking about suicide is to help them come up with reasons to go on living, and one of the ways that mental health specialists have traditionally done this is to work with their patients to create a “hope box”—a collection of various items that remind the patients that their lives are meaningful and worth living. The items can be anything from photos of loved ones and certificates of past achievements to lists of future aspirations, CDs of relaxing music, and recordings of loved ones offering inspirations thoughts. The hope box itself can take various forms: a real wooden box or shoe box, a manila envelope, a plastic bag, or anything else that the patient chooses. The patient is asked to keep the hope box nearby and use its contents when it seems hard to go on living.

But it is not always easy to keep such a hope box close at hand. A depressed Veteran or service member might find it inconvenient to take the hope box to work, for example, or might forget to bring it along on a trip. For this reason Nigel Bush and his colleagues at the National Center for Telehealth and Technology have designed a “virtual hope box,” a smartphone app that allows the patient to keep all those reasons for living close by at all times.

The entire app description is here.

Saturday, July 9, 2016

Facebook Offers Tools for Those Who Fear a Friend May Be Suicidal

By Mike Isaac
The New York Times
June 14, 2016

Here is an excerpt:

With more than 1.65 billion members worldwide posting regularly about their behavior, Facebook is planning to take a more direct role in stopping suicide. On Tuesday, in the biggest step by a major technology company to incorporate suicide prevention tools into its platform, the social network introduced mechanisms and processes to make it easier for people to help friends who post messages about suicide or self-harm. With the new features, people can flag friends’ posts that they deem suicidal; the posts will be reviewed by a team at the social network that will then provide language to communicate with the person who is at risk, as well as information on suicide prevention.

The timing coincides with a surge in suicide rates in the United States to a 30-year high. The increase has been particularly steep among women and middle-aged Americans, reflecting widespread desperation. Last year, President Obama declared a World Suicide Prevention Day in September, calling on people to recognize mental health issues early and to reach out to support one another.

Monday, July 4, 2016

Experts worry high military suicide rates are 'new normal'

by Gregg Zoroya
USA Today
Originally published June 12, 2016

Seven years after the rate of suicides by soldiers more than doubled, the Army has failed to reduce the tragic pace of self-destruction, and experts worry the problem is a "new normal."

"It's very clear that nothing that the Army has done has resulted in the suicide rates coming down," said Carl Castro, a psychologist who retired from the Army in 2013, when he was a colonel overseeing behavioral health research programs.

The sharp rise in the Army's suicide rate from 2004 through 2009 coincided with unusually heavy demands on the nation's all-volunteer military, as hundreds of thousands of troops, most of them in the Army, deployed to Iraq and Afghanistan. The vast majority have since come home, but suicide rates remain stubbornly high.

The Army's suicide rate for active-duty soldiers averaged nearly 11-per-100-000 from Sept. 11, 2001, until shortly after the Iraq invasion in 2004. It more than doubled over the next five years, and, with the exception of a spike in 2012, has remained largely constant at 24-to-25-per-100,000, roughly 20% to 25% higher than a civilian population of the same age and gender makeup as the military.

The article is here.

Sunday, October 11, 2015

Blocking the means of suicide can buy time and lives

By Karolina Krysinska and Jane Pirkis
The Conversation
Originally published September 23, 2015

Installing barriers and safety nets at public sites with a high incidence of suicide can reduce the number of deaths at these sites by more than 90%, according to new research we published today in The Lancet Psychiatry.

More than 2,500 Australians died by suicide in 2013 and more than 20,000 are admitted to hospital every year as a result of self-harming behaviours. Suicide also affects those who are left behind – the bereaved, who often struggle with guilt, social stigma, and the question of why.

Our study investigated interventions to prevent suicide at public sites that gain a reputation as places where people have taken their own lives. These are usually easily accessible sites, such as bridges, tall buildings, cliffs, or isolated areas, such as woods.

The entire article is here.

Tuesday, July 7, 2015

Guns, suicide prevention, and backwoods lifestyles

By Massad Ayoob
Backwoods Home Magazine
Originally published June 2015

Things to look for

Don't expect the warning signal to be as obvious as "Hey, I need a gun ... and one cartridge." When someone known to you as a non-gun owner asks to borrow a gun, quiz them as to why. Don't make it an accusing "Whaddaya want a deadly weapon for?" Instead, say something like, "Well, guns are tools. If you asked to borrow one of my tools, I'd ask you if you're going to cut boards or pound nails, because that would help me to decide whether to lend you a saw or a hammer. Different guns are for shooting different things. What do you need to shoot?" And take it from there.

An answer like, "I just need a gun!" is a red flag. More questioning — and analysis of answers — is indicated. In the NHFSC program, gun dealers are taught to ask, "Do you have a cleaning kit?" A "yes" answer is fairly copacetic. The cryptic "I won't be needing that" may be another red flag.

If a neighbor asked to borrow a chainsaw or your backhoe or something in between, one of your first questions would be, "How experienced are you with that equipment?" If the answer was anything from "It doesn't matter" to "None of your business," I doubt you'd be lending them that gear. The same must be true with a firearm! If the person requesting is someone you know or suspect has little or no knowledge of firearms operation and safety, invite them to a firearms safety session. If the answer is anything like "I don't need it" or "I don't have time for that," another red warning flag is flying.

You, the friend/relative/neighbor, have an advantage the person behind the gun shop counter does not: You know this person. Apply that knowledge to their request for a gun.

Have they been depressed lately? Gravely ill? Suffered the loss of a loved one, or a crushing economic reverse? Have they been recently dumped by a lover or spouse? I put the latter in italics for two reasons: It seems to be a particular trigger for the departure-from-life impulse, and it's associated with not just intent to commit suicide, but sometimes, intent to commit murder as well. All of these can be red flags.

When someone you know asks to borrow a lethal weapon, and it seems out of character for them to do so, be particularly alert for signs of "departure ritual." The person who has committed herself to leaving life behind will often put her affairs in order. The person who has been chronically tardy in paying bills suddenly brings all accounts up to date, for example. Conversely, in one case I worked, the individual burned all his bills in a ritual bonfire the night before he committed "suicide by cop," attacking police with a weapon and forcing a sergeant to shoot him to death.

The entire blog post is here.

Massad participated in an Ethics and Psychology podcast that can be found here.